‘Maximize Your Benefit’ May Lower
Out-of-Pocket Rx Costs

A new program introduced by Humana in April 2001 may help fully insured members save money on prescription costs. Called Maximize Your Benefit (MYB), the program identifies members who are taking prescription drugs in Level Three, which contain mostly brand-name drugs on the Humana Drug List, and informs them of possible lower-cost alternatives in that therapeutic class. In July, Humana rolled out the program to members in self-funded plans.

MYB is intended to help address the impact of the trend toward direct-to-consumer (DTC) advertising that has been influencing consumer behavior in recent years. Since DTC advertising became widespread, both members' and Humana's costs have increased substantially for many of the drugs that are heavily advertised on television and in print publications.

The MYB program, which is primarily a communication effort, addresses members who are taking certain high-priced brand drugs — those in Level Three — for which there are possible alternative therapeutic equivalents in Level One or Level Two. In February 2002, after selecting five specific drugs, Humana began contacting adult members taking one of those drugs, using voice application technology (VAT). The program works like this: members receive a phone call during which they are informed that there may be less expensive alternatives to the drug they're taking and are encouraged to talk with their physicians about whether a possible alternative with a lower copayment might be appropriate. For example, members who receive a prescription for Aciphex or Prilosec, which are in higher cost levels on the Humana Drug List, may receive the communication. In this case, possible alternatives might be Prevacid or Protonix (lower-cost brand-name drugs on the Humana list), or the generic drugs ranitidine or cimetidine, which are also on that list. It is always up to the physician to determine the appropriate drug.

At the end of the phone call, members can request a letter to share the cost-saving information with their physician. (The actual copayment amount depends on the individual member's prescription drug benefit plan.) Although it is too soon to measure results, to date more than 98 percent of members contacted have requested the follow-up letter. As such, it is likely that members will call physicians' offices to discuss possible alternatives to the drugs they've been prescribed.

Since 2001, Humana has used a similar education strategy in a mail-based initiative in which possible lower-cost alternative drugs are identified for the five target drugs. In recent months, Humana has augmented the member-education effort by sending e-mail messages, delivered through members' MyHumana personal home pages in a secure format.

As of September 2002, Humana had sent 260,000 letters, placed 26,000 VAT calls and transmitted 12,000 e-mail messages. Through September 2002, nearly 14.2 percent of members contacted had converted to a lower cost drug. In the control group, which did not receive a call or letter, 6.6 percent of members taking drugs in Level Three switched to lower-cost drugs within six months of starting the initial prescription.

"We expect to see a higher conversion rate this fall because of improvements to the letter and increased use of the VAT system," said Julie Dickinson, Humana's director of pharmacy benefit management.

In an effort to help members better understand their drug benefits and ultimately maximize the ways they use those benefits, Humana makes prescription drug information available on its Web site, www.humana.com.

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